Health Care Debate Heats Up

11/17/10 Kimberly Vlach
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Tuesday night, members of the Pinellas County Medical Association met at Bayfront Medical Center in St. Petersburg where two doctors debated health care reform and the Patient Protection and Affordable Care Act.

Dr. David McKalip and Dr. Mona Mangat went head-to-head for nearly two hours. McKalip, a neurosurgeon, calls for its repeal. Mangat, a physician specializing in allergies and asthma, supports it and sees it as a first step in reform.

Both agree that insurance companies are hurting the health care system as it stands now.

Mangat: "Insurance companies are in charge. They decide what treatments we can offer. They dictate what prescriptions we can write. They deny claims at will, sometimes just for not dotting your 'i' or crossing your 't'. And they impact how compliant or non-compliant our patients are."

McKalip: "The more you spend on the patient the less goes into your pocket. If you spend too much on your patient the insurance company, who now has immense power, will come and complain and get you thrown off the panel. You'll cry for help and you will not get it because it's that insurance company that's keeping the government and the politicians in office."

However, McKalip says that a free market, one in which the government doesn't interfere, is the best way to ensure cost control. He says market forces and the laws of supply and demand will dictate prices. But one audience member fervently argued on behalf of consumers who are struggling against rising premiums saying people are helpless against the insurance industry. But McKalip fires back.

McKalip: "When do you think the insurance companies are going to have more power? When everyone's mandated to buy their insurance and the government defines what insurance is? Are you going to have more power as a patient and a doctor to set your prices or less power?"

Audience member: "No, you get rid of the insurance companies. You take them out of the equation. You have a single payer system and you take the insurance companies out of the equation."

In a single payer system like Medicare, all medical bills are paid for by that program, but since a single payer system isn't what the Patient Protection and Affordable Care Act addresses, Mangat points out that the new law will create health care exchanges where health insurance companies will have to compete for consumers, and in competition, the best services should win over customers.

"The state will have the power to set up exchanges where insurance companies will have to compete for all these new lives that they want, they're going to have to give a better product at a lower price, but they're going to have to offer a basic set of services so that nobody's going to buy some crappy plan that costs $10 a month and gives you nothing for the money. So, it's going to cause competition, it is taking these free market ideas, but it's using them in a way that will actually allow us to help people, not just let those that are healthy and wealthy to be helped and nobody else."

Mckalip says the government is overstepping their boundary and that people are responsible for their own healthcare needs, but Mangat says that doctors need to advocate for those who can't advocate for themselves.

Mangat: "And I personally feel that health care is a human right. I don't think that it matters if you're rich or you're poor. I think you should be able to have access to care equally and fairly for all people."

McKalip: "Medical care is neither a right nor a privilege, it is a service. It is a service that people like you and I provide and that people plan to pay for when they need it. If you consider it a right, please find where the right is defined in the Constitution of the United States."

The Universal Declaration of Human Rights says every person has the right to medical care. It was adopted by the United Nations General Assembly and signed by the United States. While health care has become a multi-billion dollar industry that can be accessed across global stock markets, one person asked if it's right that health care be treated as a commodity.

Mangat: "No, I do not think that health care should be treated as a commodity and I think it has been treated in that way. People have made profit off of misfortune, illness, death, off of human life. I completely agree with you that that should not be the way that it is."

McKalip: "Profit is the most moral force in our society. Because through profit man is held accountable to each other. A man must justify why they should take your money in exchange for a service or a good."

Passions ran high in the forum where a few audience members - healthcare professionals themselves - voiced their opinions, unsolicited. It is clear that McKalip sees power and advantage in keeping health care a capitalist industry while Mangat's concerns lie with fairness and equal access.

Make no mistake, Mangat was clear that a 20% reduction in Medicare reimbursements would cripple her practice. But she voiced her support for the Affordable Care Act in favor of helping those who need help.

Universal Declaration of Human Rights

Previous WMNF coverage of the Affordable Care Act

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Hooray for health reform!

Hooray for fairness and equal access! Hooray for health reform, imperfect though it is. Let's keep taking important steps forward in reform of a broken health system.


A 20% cut in Medicare reimbursement has NOTHING to do with the PPACA. It is a result of the incredibly flawed SGR formula which partisan politicians have repeatedly, under multiple administrations, failed to fix.


Totally agree with Dr. Mangat. An unregulated free market would only leave out more and more of our friends, neighbors, families, and communities. It would be far worse than AIG and the entire financial crisis. That's why doctors across the country and all of the 10 largest physician medical societies support health reform.


Let's not forget, SGR was the creation of Newt Gingrich's Congress; It was a way to kick the can down the road so as not to have to make tough choices about spending. It's time to make some decisions, folks! Fairness and access to care is what we should be all about, as physicians and as a country.

Free market health care

When doctors are going to stop treating patients like a commodity? "Free market health care" is code word for "I am the doctor and I am free to make as much money off my patients, free to do as I please eventhough my brand of medicine is quackery, charge and cheat as I see fit, and discriminate against patients of my choosing".

Reality check

Let’s not forget, “We have put America’s fiscal house in order again,” exulted President Bill Clinton who signed the bill into law.” July 30, 1997 as he signed the bill enacting SGR into law. Unfortunately for those doctors who rely on the 50% reimbursement rates of Medicare to survive and don’t have a Botox/Hair removal business on the side, a 20% cut in reimbursement will mean closing the doors and leaving patients in the lurch.


Thank you Dr Mangat! You are so many things: a mother, a physician and a small business owner who brings so many interesting perspectives to this debate. Thank you for understanding that health care delivery is changing - whether we like it or not, for being brave enough to voice your opinion, for using your knowledge to educate others, and most of all, thank you for fighting for the 50 million uninsured in this country! Lastly, I really appreciate that you have never stooped to name calling or personal attacks in promoting your ideas. You have always maintained a civil discourse with the public and your own colleagues despite high emotions. Please continue your work and know that many physicians, myself included, support you and the ACA 100%!!!

You may feel a little prick….

I agree that we need either healthcare reform or health insurance reform… but… if you would like to see a sample of US government run healthcare in action… you need go no further than your local VA Hospital. What could possibly go wrong in one of those???

An MD who supports reform

The health reform law is a big step in the right direction, and a good basis to begin getting the USA as good a healthcare system as other modern democracies have now.

About the VA hospitals

Dr. Pendergrass is misinformed and uninformed. No one is proposing the government owning ALL hospitals and ALL doctors and running the whole show because the VA system is exactly that. Not even close. Uninformed doctors should stop fear mongering by suggesting that health care reform equals government run health care or VA hospitals. In a famous study run by Forbes Fortune magazine (a pro business magazine), among all health care systems in existence in the US, the VA hospitals system was selected as the best model for the high quality care and the ability to keep control on the costs over the years and having the best electronic medical record system over the past 10 years. There are areas and certain VA hospitals that one can pick on, but overall the system is a pretty good one. BUT, no, not Obama, not Congress proposed to convert the current health care system into the VA system. Please get your facts right.

Please... call me Dr. Phil Goode

Dude... what facts did I get wrong??? Are you saying that the VA Hospitals are not government run??? And seriously… what could possibly go wrong in one of them??? I don’t know of a single veteran that carries extra health insurance on themselves… (except me)... because they know that they can get what they need from a VA Hospital. What veteran in their right mind (me)... would pay extra for something that they don’t need??? So… what facts did I get wrong???

One and done...

Yo… doc… you were right. I only found one VA Hospital that had problems in 2004, 2006, 2007, 2008 & 2010… but I stopped looking after my first try. Anyway… fear not…it was some little clinic thingy in the middle of nowhere… so obviously there wasn’t any government oversight. Let’s see… it was called… “Walter Reed”… I wouldn’t worry about it.

Nice try, but not really...

Dude, Dr. Pendergrass, here are the facts you got wrong: 1) Walter Reed is a military hospital. Not a VA hospital. Strike 1, dude. 2) The VA health care system has better outcomes for the most important chronic diseases cared for by Primary Care than any other hospital system in the country and perhaps the world. see Philip's Longman's "Best Care Anywhere" and a Businessweek review (2006): Where are your references, doc? ... Strike 2, dude. 3) The new health reform law does NOT do anything to establish any government-run hospitals or government-employed physicians. It doesn't even establish any new government-run insurance; it only expands the eligibility of current medicaid. The goverment regulation is over Insurance companies and their products, Not the health care that docs and hospitals provide. Strike 3. I am an internist at a VA in Chicago, a tertiary care center with every major subspecialty, a referral center from the Midwest, and the preferred medical center for even those Vets who have private health insurance. We're not too shabby over here. Everyday, I see a new patient who has just lost his job and his insurance and thanks us for being here for him or her. Dr. Pendergrass, dude, you don't know what you're talking about.

Headed for the showers???

What do you mean I’m out??? I’d like to get a review those strikes!!! Let’s see … the first pitch was… a military hospital or a VA Hospital??? Both, are run, backed and overseen by the government… whoahhh… a curve ball… strike one!!! Then the next pitch was… I gave no references to support myself … and no matter how you look at it… that’s a foul… strike two!!! Now… the third pitch was… “The new health reform law does NOT do anything to establish any government-run hospitals or government-employed physicians. It doesn't even establish any new government-run insurance…” now that one is definitely a fastball… but from here… it looks a little low and inside. While we’re waiting for the official call on that third pitch… I’d just like to say… running up against a relief pitcher like Dr. Krishnamoorthi… for me… keeps this sport challenging, interesting, fun and above board… excellent throws Doctor. Now… back to the game… I still think that third pitch was a ball… where’s the umpires when you need them???

Not the showers... he's taking first base!!!

Hay… Dr. Ram… I think we’re about to get a ruling on that third pitch. You know, the one that says’ “…It doesn't even establish any new government-run insurance…” Well, I went to just to check out what was happening and when was it going to happen. Guess what… “Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too.” So I thought… that’s cool… we can get the same insurance that our government has. But… what is this thing they call “EXCHANGES”??? So… I went to the Kaiser Family Foundation…”Focus on Health Reform”… ... and found the answer. “…An exchange is part of the plan aiming for universal coverage currently being implemented in Massachusetts (where it is called the “Connector“). It was also featured in proposals from the major Democratic candidates for President (including President Obama), in the Healthy Americans Act sponsored by Senators Ron Wyden and Bob Bennett (where they are called Health Help Agencies), and in a white paper released by Senate Finance Committee Chair Max Baucus…” So I’m like, “Dude… that third pitch was definitely low and inside… it’s like… a ball fursure!!!” And then I read it… in a section called “Key Questions”… question #3… “How should an exchange be governed?” And the answer was in the first sentence… “The functions of an exchange could be handled by a federal or state government agency.” DUDE… not only was that third pitch a fastball, low and inside… I think you may have beaned the batter!!!

More straightforward than the baseball rulebook...

Dr. P, I love your sense of humor, and your clingy-ness to metaphors. So I'll try to oblige you furhter: I'm sorry, this isn't backyard wiffle ball. You can't stand there and argue the balls and strikes because, frankly, the umpire is none other than the truth. You see, unlike the 5th grader discussions and spats that take place on Faux Noise, in this game we're actually using facts and statistics and, like, real stuff. And, most importantly, we're respecting the complexity that already exists in the health care system. That's right, complexity. Stuff that is hard. Not simplistic. Not unverified lies. The members of congress already get insurance that is Not government-run insurance. Rather, they get private insurance plans from Blue-cross, Aetna, and others, that are specially crafted for federal employees. The Federal Employee Program, administered by the Office of Personnel Management, educates federal employees about this *wide* range of plans, which all meet certain standards that the OPM (and Congress) have set so that fed employees get certain *minimum benefits for their plans. Part of the deal. .. The Exchanges, yup, government-run, are marketplaces that are *regulated by the government, setting standards for insurance plans so that they meet minimum benefits. They do NOT own or operate the insurance plans. So when Congress-people enter the exchange, they won't be getting "government insurance"; they'll continue to shop for private insurance that is collected for them. Every year, federal employees can change insurance during the Open Enrollment season (which is now, btw). The exchanges are just like Stock Exchanges: in the NYSE or the NASDAQ, firms that want to participate have to meet their rules, so that there is better information for competition to take place. That's right, *more effective* competition. Not the ineffective competition of our current health insurance market, wrought with moral hazard, adverse selection, cryptic underwriting practices, industry abuses, sham customer "service." Listen, Dr. P, I'm a Cubs fan, ever-disappointed and ever-embarrassed by $100 million contract hitters, like Sammy and Alfonso, who swing for the wrigley ivy and end up striking out over a 150 times a year. I'm used to that, I guess. What I can't stand is someone standing at the plate after striking out and arguing that their bat nicked the ball for a foul tip. Did you put the ball in play? No? Then I think it's time to take your seat in the dugout. I agree, this is fun. I'm glad you're actually reading about the law, unlike many who spew their pre-conceived myths. Now, it's time to just open your mind to the possibility that it's not what you thought it was.

VA Rules!

I know it's popular to bash VA hospitals but every veteran I know speaks highly of the care they receive here in Tampa. They go out of their way to provide the best care possible --at no charge!

It's still a game...

Dr. K… as long as I’m not being thrown out of the game… I’m okay with it. But dude… I’m still having problems separating government run health insurance and privately owned health insurance being exclusively available (and micro-managed) by government run “exchanges”… also… will the American people have the same type of insurance coverage as those Congress-people??? Everyone keeps trying to convince us that the only thing that’s changing is the increased availability of health care. Yet, in the news today was an article about 700,000 seniors losing Medicare coverage… added to those… insurance companies are dropping separate child coverage… and… corporations like McDonalds threatening to drop insurance plans for 30,000 employees unless they get wavers from the health care laws. And McDonalds was only 1 of some 30 companies (including unions) getting wavers from the health care law. Those “exchanges” aren’t going to be open until 2014… and close to 1 million people are on the verge of losing their coverage today… as a result of passing the law. I don’t care how complex this “stuff” is… at this rate… by 2014 there will be so many people that lost their coverage… the government will have to take over the industry… just to “save it from itself”. You’re right… this aint waffle ball… but it is a game. Do you honestly believe that no one in government saw these potential repercussions???

little league

Dude, "Dr." Penderass, you're not even in the stands at this ball game. Do us a favor and look something up before taking a whiff. This is from a simple google search on "health care exchange" and out of several, I chose the Christian Science Monitor. An excerpt.........Who will the customers be? Not you, if you work for a medium or large company, and if your employer offers health insurance benefits. That sort of arrangement is grandfathered in, according to the legislation, and can continue pretty much as before. In their initial years, the exchanges will be open only to those who work for firms with 100 or fewer employees, and to individuals looking to buy insurance for themselves. Because they’re self-employed, for instance. Or unemployed. Or retired but not yet eligible for Medicare. As all who have tried to buy health insurance on their own know, currently most policies available are much more expensive than comparable products offered to big firms. Partly, this is because big firms can offer lots of customers, both healthy and less so, so that insurers know they can spread their risk. The exchanges are meant to be cooperatives that allow these individuals to band together and, for health insurance purposes, become like their own big firm. .....So, Dude, you could create your own little exchange and you might get enough of your friends to join in with you, like your own sandlot team.

Anyone shoot pool???

Dr. Krishnamoorthi… you sir, are “The Man”. When you’ve finished your internship in Chicago… please consider moving to the Tampa Bay area… and thank you for the education. I may not be 100% convinced that what we’ve done is going to be better… but... because of you... I will be much less skeptical on the subject.

Behind the 8-ball…

Hay… Dr. K… like I said, "we need either healthcare reform or health insurance reform…" Check out this article in the Politico today ( Based on the new healthcare “rules”… insurers may only use 15% to 20% of the premiums collected to spend on administrative costs and profits!!! Let me ask you as a businessman… would you go into a business that had a government cap on profits of 15%... knowing that your employee salaries and building rent has to come out of that 15%??? Uncle Sam may not be establishing “a government-run insurance”… but if everyone else gets out of the business… guess who I see riding in “to the rescue”?


And… oh yeah… why stop at healthcare insurers??? Let’s just go on and reform this “complex stuff”. Let’s “profit cap” the Healthcare Industry… the health providers and the drug companies. Private practitioners and dentists making 15% profits… before administrative costs… all hospital salaries umbrella’ed under a 15% profit cap. Rehab… mental healthcare… prescription meds… DUDE!!! Now we’re talking healthcare reform!!! Unfortunately… because everyone closed their doors and moved “off shore”… so they can make a profit… we’ll have to go to Upper Volta to get basic vaccinations. Well… at least the airline industry would get a “shot in the arm”.